I periodically receive emails from readers asking me to write a post reviewing this or that thyroid book. There are a few reasons why I haven’t done it, but the overarching explanation is: thyroid books are generally worthless. Like The Bachelor(ette) television franchise, these books tend to follow a formulaic arc, promising “the most dramatic improvement in your health, ever!” First, they seek to identify with the reader – are you sick and tired of being sick and tired and getting nothing but shrugs from your doctor? Second, they overstate the prevalence of clinically meaningful undiagnosed thyroid disorders in the population, leading you to believe if you haven’t yet been diagnosed, you can rest assured that it’s definitely your thyroid. Third, they launch into a lengthy discussion/diatribe about how mainstream physicians refuse to order the testing that could diagnose your thyroid condition. Fourth, they regurgitate a bunch of filler that’s covered elsewhere on the web about diet, exercise, sleep, supplements, etc. Finally, they offer their own “protocol” for defeating your hypothyroidism and regaining control of your health.
After all that, you are left either no better off or, perhaps worse off, due to spinning your wheels following advice that is clinically unsound. Along those lines, after years of Chris Harrison (host of The Bachelor) promising me “the most dramatic season ever” – every season – I have finally cut the cord and stopped watching. It got to the point where I was watching The Bachelor only to get to know the contestants well enough to appreciate the drama of Bachelor in Paradise, the more ridiculous yet slightly more entertaining spinoff show. Like a lousy thyroid book, I’ve slowly learned to accept that every season of The Bachelor is exactly the same. Each episode is edited such that what airs is merely different people spouting precisely the same platitudes as their predecessors from previous seasons. So yeah, I’m equating wasting my time watching reality TV drivel with wasting my time reading and then writing about thyroid books that proffer the same nonsense we’ve all already heard. If I ever write a thyroid book, you can bet your rear end that it will be the Survivor* of thyroid books.
You Can’t Eat for Your Thyroid
Although I don’t plan to review a specific thyroid book today, I thought I’d do a deep dive into one of the pervasive myths found in these books – that you can eat/avoid certain foods to optimize your thyroid health. Like most of the nonsense that litters the internet about the thyroid, much of this starts with a kernel of truth and then veers off into the woo-o-sphere. With that preamble, let’s debunk!
Myth: You must avoid cruciferous vegetables.
If you try to avoid cruciferous vegetables, you might as well say, “I’m just going to stop eating vegetables.” Okay, that’s a bit hyperbolic, but veggies from the Brassica genus include broccoli, kale, turnip, Brussels sprouts, Chinese cabbage, cauliflower, and a host of others. [HD: Warning, this gets dense for a few sentences!] The “problem” with Brassica vegetables is that they contain substances known as glucosinolates. Glucosinolates are acted upon by an enzyme called myrosinase – found in adjacent plant cells – typically during the process of chewing. This enzymatic reaction leads to the formation of isothiocyanate, some of which breaks down to form a permanently charged thiocyanate ion. In addition, there is a glucosinolate called progoitrin that breaks down to goitrin. Read on to learn the mechanisms for why thiocyanate and goitrin could be bad for the thyroid.
Thiocyanate is a competitive inhibitor of the sodium/iodide symporter on the basolateral membrane of the thyroid follicular cell. Because the thyroid needs the symporter to grab iodine in order to make thyroid hormone, and thiocyanate competes with iodine for uptake by the thyroid, this could reduce thyroidal uptake of iodine and lead to decreased synthesis of thyroid hormone.
The question is, does that actually happen in a clinically meaningful way? There aren’t many human studies, but one actually added thiocyanate to milk consumed by human volunteers for 12 weeks. They were able to show an almost doubled blood level of thiocyanate, but unchanged levels of T4, T3, and TSH. It turns out that the amount of thiocyanate increase in the blood you would see from consuming 100g (3.5 oz) of many Brassica vegetables is only about 10 μM. Since human control subjects have baseline thiocyanate levels of 40-121 μM, it seems very unlikely that a normal serving of these vegetables would bump thiocyanate levels enough to interfere with synthesis of thyroid hormone.
Goitrins also have the potential to interfere with thyroid hormone production, as seen in many animal studies. There is no data on what constitutes a normal level of goitrins in human blood, so we really don’t know how to define the safe dietary threshold. Again, there isn’t much high-quality human data, but one study found that it took 77 μM of progoitrins to suppress thyroidal uptake of a diagnostic dose of radioiodine. As you will recall from the preceding paragraph, a 100g serving of broccoli has only 10 μM, so it seems far-fetched that a normal serving of vegetables would supply enough goitrins to cause a huge problem.
The only journal article reporting a negative effect of Brassica vegetables on thyroid function was a case report of an 88 year-old woman with diabetes, who was ingesting 1.5 kilograms of raw bok choy daily for several months. Temporarily tabling the fact that I can’t imagine eating that much cooked bok choy, let alone raw bok choy, why would anyone do this? Did her naturopath recommend it? The paper didn’t say, but she believed that it would help control her diabetes. In her defense, if she wasn’t eating much else – I don’t see how she could, with all that bok choy clogging up her stomach – her blood glucose probably looked awesome. Unfortunately, she presented to the hospital in myxedema coma, a state of profound hypothyroidism.
Fortunately for all you bok choy lovers, cooking Brassica vegetables inactivates the myrosinase enzyme that leads to the formation of thiocyanates and goitrins. Unless you are eating truckloads of raw Brassica vegetables on a daily basis, your thyroid is going to be just peachy. Not only that, but glucosinolates are known to be cancer-fighting compounds, so I would not recommend restricting vegetables that contain them (though raw vegetables may have more potent cancer-fighting ability than cooked, for the reason stated above). If you want to read more about cruciferous vegetables and the thyroid, check out this great review article.
Myth: You must avoid soy.
Soy has garnered quite a bit of negative attention when it comes to hypothyroidism. People got all bent out of shape back in the 1950s – 1960s when several cases of infant goiter were reported with soy formula. However, it soon became clear that this risk was eliminated with the addition of iodine to the formula.
The pathophysiology stems from the fact that soy is particularly rich in isoflavones, when compared to other plant foods. In rats and in test tubes, these isoflavones have been shown to inhibit thyroperoxidase (TPO) enzyme activity. Because TPO catalyzes iodination of T4 and T3 in the formation of thyroid hormone, interfering with it could lead to hypothyroidism. Isoflavones also compete with tyrosine for iodination by the thyroid, and tyrosine is used in the formation of thyroid hormone. But, research has shown that this competition is negligible and clinically irrelevant.
Despite their potential for causing problems, at least 13 clinical trials have shown that isoflavones have no effect on the thyroid function of euthyroid people. In other words, if your thyroid function is normal, eating soy isn’t going to cause it to slow down. Admittedly, trial data is tough to interpret and extrapolate, as almost all trials use isolated soy protein (ISP) as opposed to less processed food like tofu. But, since the isoflavone content of ISP is probably going to be a little higher than the tofu you find at the supermarket, it is likely safe to say: if ISP in the trials didn’t cause hypothyroidism, tofu and other soy products won’t either.
On the flip side of the coin, there was one Japanese trial showing that consumption of soy in the study subjects led to goiter. Unfortunately, this study was of lower quality than the other 13 trials above. There was no control group, and the soy content of the product administered to study subjects was not described in detail. In addition, based on the way the authors did describe their intervention, it seemed like the soy content of the study medication may have actually been lower than the amount of soy euthyroid Japanese people typically consume on a daily basis. Combining this fact with the fact that no other trial showed results of this nature, it makes their results highly implausible.
Now, there was one British study that actually looked at giving soy to patients with subclinical (borderline) hypothyroidism. They used pretty high doses of a soy phytoestrogen and found that several subjects progressed to overt hypothyroidism.
The last thing I should mention about soy is that it does interfere with the absorption of thyroid hormone pills, so people with hypothyroidism do need to be careful about eating soy too close to their morning dose of levothyroxine. But, since any food in the stomach has the potential to decrease levothyroxine absorption, this effect of soy is not really unique and shouldn’t deter people with hypothyroidism from eating it. I think the only people who might run into trouble are hypothyroid folks who consume large amounts of soy throughout the day. Because there is some enterohepatic circulation of levothyroxine, the constant presence of soy in the gut could lead to decreased absorption of the ingested thyroid hormone, even many hours after the dose has been taken.
In conclusion, euthyroid people do not need to worry about soy hurting their thyroids. People with borderline hypothyroidism who consume large amounts of soy might want to consider a multivitamin containing a normal amount of iodine (no mega doses!), if they live in a region where iodine deficiency exists. That would likely mitigate the risk of developing overt hypothyroidism. People with hypothyroidism on thyroid hormone replacement therapy can eat soy in moderation, as long as they don’t eat a ton of it within several hours of taking their levothyroxine.
For more information about soy and the thyroid, check out this good article.
Myth: You should eat seaweed or take mega doses of iodine-containing supplements.
Iodine is necessary for normal thyroid hormone synthesis. However, iodine deficiency in the U.S. is not very common. Nonetheless, I see plenty of patients being “tested” for iodine deficiency by their alternative medicine providers. Clearly these providers don’t know their assay, as there is no good test for diagnosing iodine deficiency in an individual. Further, the “treatment” they initiate with mega doses of iodine is misguided.
Excessive doses of iodine can actually suppress thyroid function. You heard me…naturopaths can cause people with normal thyroids to become hypothyroid by giving them huge amounts of iodine. It’s often not catastrophic, as euthyroid people will escape from this so-called Wolff-Chaikoff effect in 1-2 weeks and return to normal. But, if a euthyroid patient has underlying autoimmune thyroid disease (Hashimoto’s thyroiditis, for example), they may not escape from the Wolff-Chaikoff effect, becoming persistently hypothyroid with continuation of the iodine supplement.
People with a predisposition to hyperthyroidism also don’t handle large iodine loads very well. In these cases, the excessive dose of iodine can precipitate hyperthyroidism (the Jod-Basedow phenomenon). Bottom line: if you have good reason to believe you are iodine deficient, consider a multivitamin with somewhere around 150 micrograms of iodine.
Myth: Avoiding gluten will heal your thyroid if you have Hashimoto’s thyroiditis.
This is one of my favorites because, to the best of my knowledge, there is no good data to suggest this is true for people without celiac disease. Even in people with celiac disease, the evidence is conflicting and controversial. Some studies suggest that a gluten-free diet in patients with celiac disease can decrease the likelihood of developing other autoimmune diseases (like Hashimoto’s). Other studies show that there is no effect of a gluten-free diet on autoimmune disease progression.
The important point here is, while celiac disease is more common than was once thought, it is still a fairly rare disease. Hypothyroidism due to Hashimoto’s thyroiditis is the most common autoimmune disease. Though an individual with one autoimmune disease is at risk for others, the vast majority of people with Hashimoto’s do not have and will never develop celiac disease. Therefore, it stands to reason that most of the people who are being counseled to avoid gluten for the sake of their thyroids are being misled.
I’m not interested in getting into a debate about so-called “gluten-intolerance,” so please don’t leave long comments about how avoiding gluten has changed your life even though you don’t have celiac disease. I concede that avoiding starchy carbs is likely to have great impact on almost everyone’s health, so it is not surprising to see people feel better and appear metabolically healthier when they eliminate gluten or any other starchy foods from their diets.
It’s your turn now. Are there any other foods or supplements you’ve seen recommended to “help” the thyroid? Comment below!
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*In my opinion, Survivor is the greatest reality show ever created. I firmly believe that, if you hate Survivor, it’s because you have negative misconceptions about the show and haven’t actually watched an entire season. It is one of the most engaging social experiments ever conducted, still resonating and innovating after 36 seasons. Jeff Probst and company, you rock.
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70 Replies to “You Can’t Eat for Your Thyroid”
Thank you for putting out cogent articles on these subjects. There is so much BS that patients read, and will readily accept…and it’s helpful to have your writing as a resource.
Thanks, feel free to print it and hand it out to your patients.
Thanks very much for including the comment about iodine in form of a multivitamin.
I’ve had a recent rash of patients in PCC (IM) who are wondering about iodine deficiency. They are exclusive vegetarians and use only the Himalayan pink salt without iodine. Interestingly, the two who I’ve seen most already have autoimmune thyroiditis and are on Levo supplement anyway, so I wasn’t worried about concerns. But this MVI rec is a simple solution that I hadn’t considered.
I think you’ve hit the nail on the head when you wrote, “I concede that avoiding starchy carbs is likely to have great impact on almost everyone’s health, so it is not surprising to see people feel better and appear metabolically healthier when they eliminate gluten or any other starchy foods from their diets.” Although rather than starchy carbs (which would include oatmeal and potatoes, two high-sateity foods), I would say refined carbs. When you eliminate gluten, you have more or less eliminated cake. I think we can all agree eating less cake probably makes most people feel healthier.
It’s tough for me to get engaged in debunking dietary advice that’s 80% reasonable, although it does grate on my nerves how extreme people can be. People quit sugar, then become convinced sugar is evil in even the tiniest quantities. No one ever seems to think to try reducing sugar by 80 or 90% and then seeing how that feels. There’s a world of difference between drinking three 12-ounce Cokes a day and having half a sugar in your morning tea. There is a world of difference between a 500-calorie breakfast muffin and an 80-calorie slice of wheat toast. BUT. It’s also true that following simple, hard-and-fast rules can be easier for some people than, for example, keeping a running count of how your daily macros are balancing out and adjusting your food choices accordingly.
For me, it’s really hard for me to stop myself from trying every new thyroid diet, because I’m a pretty good dieter (it’s a rule-follower’s dream) and I have an experimental outlook anyway. But I have found that these “just try it and see” experiments of mine can waste time, money, and energy I should be putting into the big, obvious things– losing a few pounds when necessary, consistent exercise, an abundance of vegetable matter (but short of 1.5kg of bok choi!). Right now, I have friends paying $90 a month for multilevel-marketed supplements that market themselves as “thyroid-supporting.” $90 a month will buy you a lot of healthy food… and/or a family YMCA membership.
Great comments as always, Sadie. Oh, don’t even get me started on MLM!
Can I upvote this comment 1,000 times??
I mean Sadie’s comment….
What a narrow- minded commentary. I am sure you meant well or did I note a sense of false knowledge about others’ dietary or food sensitivities. Drawing anecdotal conclusions about real life issues with gluten by lumping it up with starchy foods and reducing the problem to just carbs is dangerous and dehumanizing..
I forgot to ask the obvious and most important question: where does one procure KG of bok Choi anyway?
I know, right? Even the Asian market would likely run out with that kind of volume.
A kilogram of bok choy is about 2.2 pounds. Bok choy is a very heavy vegetable, so if you eat some at each meal it is easy to eat a kilogram of bok choy a day. It is a very mild tasting crunchy vegetable, crunchy like celery and tastes better too. I enjoy bok choy often but always make sure to cook it. I use the green leafy part raw if I make a hamburger, since I have Celiac Disease and gluten-free buns and bread are pure high bloodsugar for me. The green ends make a decent sturdy bun substitute. That does not fall apart or rip easy like lettuce does.
I have Hashimoto’s and I also no longer have a thyroid
The food woo is intense. Do this diet, do that diet. I don’t truck with diets, I maintain my weight with exercise and eating in moderation. Dairy free is another common one and many take so many supplements that they must rattle. I do take vitamin d and activated vitamin d as instructed by my endocrinologist (but I have hypoparathyroidism) but it’s always you must check this long list and they must be top of the range. I don’t understand the obsession.
There are just so many of books of this ilk around. The fact is, if there is a slam dunk way of treating a particular health issue then by and large it is going to be offered by mainstream medicine, certainly in countries where health care is state funded, so simpler, cheaper but equally effective treatments are the way to go. And I have enough faith in human nature and the medical profession as a whole to think that in other funding models of health care best practice will be the norm. You know, I reckon people spend more time learning about how their new phone or whatever works than thinking about their health and health care.
Everyone is different. Some things you debunk actually work for some hypothyroid people. I am open-minded and read a lot about thyroid health. Thanks for your information.
I appreciate your open-mindedness, Deb, but I need to push back a little on your comment. First, many people want to hear that they are “different” or “special” when it comes to their health/bodies. Though I agree that doctors need to listen to their patients and construct a plan that addresses that specific patient’s needs, people overall just aren’t that different from each other when it comes to the topics I address in this post.
When you say some of the things I debunk “actually work for some hypothyroid people,” what do you mean, “work?” Avoiding vegetables, soy, or gluten could make someone feel better if, for example, she gets a stomach ache when she eats that stuff. But just because she happens to be hypothyroid and gets a stomach ache when she eats soy doesn’t mean that avoiding soy is making her thyroid any better. This may seem like semantics to some people, but it’s not. I’m trying to help people avoid spinning their wheels doing things that are unnecessary, difficult, and sometimes dangerous.
To piggyback on HD’s comment– yes, sometimes the things those books recommend do “work,” but that’s often because they take a shotgun approach and make so many recommendations, one or two are bound to be right. As the saying goes, even a broken clock is right twice a day!
As an OB Gyn, endocrinology is the basis of most of what I do. Along the same lines, is the “low testosterone “ and how we all should be on Bio T. Another useless yet very dangerous intervention people are trapped into.
Thank you for the great article.
Oh yes…bioidentical hormone replacement…one of the greatest marketing gimmicks ever that has little basis in good science.
I’m curious to hear a Dr’s approach to thyroid function and to hear that you can’t eat for better thyroid function – it’s an interesting thought. You could apply that whole statement to any gland or disease then? You can’t eat to improve heart disease or cancer implications perhaps?
It’s quite a mechanistic, neo-darwinian line of thought that perhaps everything is controlled by genes and yet medicine is the only saviour, where all disease can be controlled by medicine. After studying endocrinology with Dr’s I often found that to even consider environment and stress and the perspectives enhanced by good nutrition, was rare. Yet plenty of studies exist to confirm the interactions of foods on a variety of disease states, including thyroid. If you take mitochondrial damage, thyroid feedback mechanisms and inhibitory states induced by environmental stimulus, food can be play an extremely protective factor in prevention.
The Endocrine society has produced guidelines suggesting the pervasive effects of environmental stress on most of the modern diseases, which of course can also be affected by nutritional abundance and obesity. It’s well known that the validity of TSH is questionable (lowered or stays the same) when ACTH and cortisol (and glucagon) is elevated (can be induced simply by skipping breakfast, fasting or low calorie states) , so eating in a manner that supports optimal hormone function allows adequate thyroid function. If fasting induces a metabolic slow down by decreasing T3 and also affecting rT3, TSH and T4 than surely eating regularly with foods that provide energy is one mechanism where thyroid function that can be improved? Regular fasting may even decrease TSHR and other factors that don’t necessarily return to pre-levels very quickly.
Not sure I agree with you on the blanket statement of your blog.
Keith, I agree with much of what you say. You’re clearly a smart guy, so I assume you realize that the point of my post was to debunk some of the common recommendations made to patients by those who are misinformed.
I’m sorry It’s taken me so long to get back on this. I was in the process of completing my MSc and forgot to respond. I think there’s certainly many aspects of diet that we can do to improve thyroid function. I work with many people via a coaching model to resolve aspects of energy, sleep, mood and digestion and after working with thousands of people I honestly feel that if you start with a foundation of ‘pro-metabolic’ foods that are easy to digest, restrict the formation of serotonin and histamine you can provide a nutrition plan that is ‘pro-thyroid.’
I think vegetable fats are extremely problematic to thyroid/liver function and I’ve recently been delving into Hulbert’s suggestion of membrane pacemaker theory that suggests that lifespan is inversely related to tissue levels of PUFA, although I think he’s probably incorrect that the higher levels and increased peroxidation index (PI) are associated with a higher metabolic rate and therefore decreased lifespan (Increased PI/PUFA doesn’t seem to increase metabolism and there are several comparative studies that support this). So again, another factor that could be considered to be part of a thyroid diet?
I think I read your recent response about sugar which makes much sense to me about why sugar is rarely the problem (but like and food stuff, if you eat too much of can cause a problem). It’s refreshing to hear this from a Dr, especially when you hear the – Sugar causes cancer or Sugar feeds cancer and the fear mongering and inaccurate nutrition advice that goes with it.
On another point that I have noticed which I would value your response on. I notice that many people can present with hyperthyroid traits when stuck in the ‘stressed’ state. Increased adrenaline like state, elevated HR 90+ normal body temperature, waking to pee at night, poor blood sugar regulation etc. Often prone to chronic metabolising of fatty acids and poor glucose fatty acid cycle flexibility (which I also believe to be thyroid damaging). These people are often breakfast/meal skippers running around all day and fail to understand that getting regular food is part of the process. When you get these people to eat three square or better still eat 5-6 smaller meals per day which doesn’t require the need for more insulin. These people slow down, and after a week or two now present with a much lowered heart rate and there temperature cools now presenting with a sub clinical hypothyroid state. I think this a presentation for many who might be going to their Dr’s for an intervention but because there’s little evaluation/emphasis on understanding on nutrition (and the individual will often suggest that they eat “healthy”). Perhaps there are many that are then too often pushed to metformin, lipid lowering and hypertensives etc without addressing the stressed state? You may have heard of the cell danger response by Naviuax and I think this can explain various upregulate/downregulated responses that will normalise when stress is lowered.
Look forward to your response – Thanks Keith
I know that it’s essential to avoid high doses of MSM if you want to have good skin and hair. I took 3000 mg of MSM daily for years because I weight train and it’s helpful for the connective tissues. What I didn’t know is that MSM blocks iodine absorption which I reason would cause the symptoms of underactive thyroid/ iodine-deficiency (coarse hair and skin). MSM tablets should be outlawed. I read it takes 8 hours for a single tablet to fully leave the body.
I stopped the MSM tablets and within a month noticed a major improvement in hair and skin quality. I’m sure this wasn’t the placebo effect since I’ve tried countless ”cures” for my hair/skin problems which have failed. I didn’t get over-excited about this working.
Are there any other foods or supplements you’ve seen recommended to “help” the thyroid? Yes I certainly have. Selenium, Zinc, Ashawaga & iodine. I’ve been told that I should avoid gluten, grains, rice as it would help my slow functioning thyroid. Confused is what I am. I have symptoms of hypothyroidism yet conventional medicine doesn’t agree. I believe I do. Frankly finding a competent Physician certainly is hard. I just want to be healthy again.
Lots of other things can cause symptoms that are the same as hypothyroidism, what are the symptoms you are having? Tiredness can be from bloodsugar problems. Bad skin and hair can be from not eating enough protein. Sometimes it us a combination of poor diet and no regular exercise, a lack of exercise can cause a host of problems, from infrequent bowel movements to bad skin.
I wonder if the truth is somewhere in the middle of alternative medicine and conventional medicine. There are some studies showing benefit to Hashimoto’s patients and avoiding Gluten. But, there are not a lot of studies even on the subject. Some studies showed it was FODMAPs rather than gluten which is why people felt better. I wish there were more studies out there so a thyroid patient could get some more evidence based information. I think there are enough claims of gluten affecting autoimmune diseases of all kinds to warrant extensive studies to prove or disprove it. I myself am surprised at how hard it is to be a thyroid patient and how much conflicting information there are on both conventional and alternative medicine sides.
You’re right, in that there is a lot of conflicting information out there about the thyroid. To the best of my knowledge, there are no studies showing that avoiding gluten helps Hashimoto’s patients UNLESS they also have true celiac disease.
The above is probably the most referenced one. It doesn’t appear to be very comprehensive. I’ve seen indications that Celiac is more common among Hashimoto’s patients, though probably because people can get multiple autoimmune conditions once they have one.
Anecdotally, on patient run sites (basically the opposite of this site), many people do appear to benefit from cutting out certain foods. Is it placebo? Possibly. If we could only bottle the ability to affect our bodies through placebo on demand.
I know for me (though still trying to get my Synthroid dialed in after 1.5 years), changing my diet away from Gluten and Dairy gave me good stools for the first time in years. I believe it maybe the dairy though. Or it could be my thyroid levels finally coming into range from a TSH of 71. My family appears to have a problem with Dairy. My mother has an allergy to it which has developed over time. My three sisters (two of which also with Hashis) are sensitive to it. Also blessed to have a Father with Hashis. I guess I was due.
The paper you reference studied women with Hashimoto’s and positive TTG antibodies (the screening test for celiac disease). In those cases, which probably involve people with true celiac disease, a gluten free diet is certainly indicated.
The problem is people who extrapolate that to infer that a GF diet is good for ALL people with Hashimoto’s – not true.
Ahh…well, I think that would be obvious that someone with Celiac would benefit from going GF. And of course their numbers will get better given that they may actually start absorbing things. I do find it odd there are not a ton of studies on this as it’s so commonly discussed with autoimmune conditions.
Calcium can block your thyroid medication, so stopping dairy could be helping you absorb the medication better. If you take a calcium supplement, you need take them four hours apart, also. And taking your thyroid medication an hour before eating breakfast was shown to improve thyroid bloodlevels in studies published on PubMed.
Autoimmune problems tend to multiply as you get older. I started with the thyroid, then arthritis, and years later was diagnosed with Celiac Disease. And then later developed Hyperparathyroidism, and had to have a Parathyroid tumor removed. No fun.
Looks like it’s being looked into a bit by science (gluten affects on autoimmune). http://pubs.sciepub.com/ijcd/5/4/6/
I think it would be great if it was more studied so we can have some evidence based information for or against it. I’d like to see other more extreme diets researched as well such as AIP (Autoimmune Paleo Diet). There are enough people looking into this stuff (and some claiming results), that I believe it warrants exploration. It’s difficult for me to know what exactly has helped as I did diet and thyroid hormone replacement at the same time. And I know you are not a fan of antibody test results, but mine have steadily came down over the past year on my diet. 1980 at first and now 100. Either way, more studies would provide the thyroid patients some direction.
Since the diet is working for me, I’m not going to stray (though many of the aspects of it came from my endocrinologists (limit processed foods, eat low glycemic/ low sugar, etc). However, I am very wary of most functional providers and this website has become a good counterpoint on many subjects. As you state, there are harmless functional providers and harmful ones. The harmful ones scare me for people out there and I try to let them know what they are being told to do could be quite dangerous.
I also now know exactly how to interact with my Endocrinologist and ensure I don’t go into any of the alternative stuff (unless it’s relevant to the treatment like what supplements I may be taking). I think many patients don’t know what information is alternative and what is conventional…so it can be hard to figure out how to talk to their doctors.
Functional medicine physicians can be very helpful. I saw one for a consult, because I was getting so sick and none of my physicians, including my endocrinologist could find anything wrong with me.
I took in all my bloodwork from the previous three years, waited in the waiting room for an hour while while he reviewed them, and then went in his office yo talk for an hour consult.
The very worst thing out of his mouth was…” You have Hyperparathyroidism, and you need an operation right away. He gave me the name of the Norman Parathyroid Center. Two weeks later the operation was done, and the next say I felt better than I had in years.
It has been two years since the operation, and the severe osteoporosis I had has now reversed yo normal bone mass, my teeth that were transparent and crumbling, are now opaque again and stopped splitting and coming apart.
My endocrinologist knew I had hyperparathyroidism, he told me he was “keeping an eye on it”. My primary physician had me on 10,000IU of vitamin DDora day and my bloodlevels were always below 20, the physicians at Norman Parathyroid Center said I could have died if a stroke from taking so much Vitamin D3, as the body will store the D3 in the tissues when you have a Parathyroid tumor and secrete calcium in the urine causing the osteoporosis.
So the $150 I spent on the functional medicine consult saved my life. It was worth every penny. And I now double check every single thing my physicians do and test for, and am very proactive in asking questions.
OK. I finally found a real study which showed improvements using an AIP diet (similar to what I do). There have been many people who appear to benefit from this diet related to autoimmune diseases (my sister has noticed improvement also). While this could be related to just eating healthier, I think it warrants more studies. But this is the first real study I’ve found: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5647120/
All this being said, I feel AIP is sort of a last resort diet and would rather start simple with eliminating gluten, dairy, soy, processed sugars. But people really suffering, or in the above people with IBS, it is something to try.
This study is about IBD (inflammatory bowel disease). I would not extrapolate it to autoimmune thyroid disease.
Understood this wasn’t Hashimotos, but it was Crohns and UC. People have been having success with this type of diet for all kinds of autoimmune situations. However, I caution people should be very careful when doing such a diet. It would be best to do it with a dietitian (which I did get some help from one) and your doctor. It’s very restrictive, and I look at it as a last resort to go full on with it. It’s hard to get enough calories when on this diet and you have to be careful to track nutrients. Still, it’s shown a lot of promise and a lot of people have had some very good results. This is the only actual study I know of, but I assume more will eventually come in the future. That being said, there is more to healing than just food. Lifestyle changes can make a big difference and should be done at the same time. Sleep, exercise, stress reduction are all important for someone with autoimmune issues. Diet is just one part of the puzzle.
A few years before I was diagnosed with autoimmune thyroiditis I developed an allergy- like sensitivity to plants in the nightshade family. (Allergist skin tested some fresh nightshade vegetables with no histamine response, but strong respiratory and gastrointestinal reactions to inhalation* or ingestion). I’ve read claims that nightshade sensitivity are related to hashimoto’s and they are expressly forbidden in the autoimmune paleo diet. Does this idea hold any water for you?
*Not huffing potatoes and pepper, but rather I have bronchospasm when peppers and eggplant are aerosolized with chopping or cooking.
I don’t think avoiding those types of vegetables would have any impact on one’s Hashimoto’s.
I’ve found that I don’t react well to spicy foods since dealing with Hashimoto’s and Hypothyroidism. The good news is, you maybe OK with other nightshades, just consider avoiding the ones with capsaicin (basically the hot ones). I remember biting into a raw Jalapeno (which I used to do all the time), and it shot a huge shock through my body. One of the weirder things I’ve experienced. My guess is it has to do with the body not being optimal (I was pretty hypo at the time). Spicy food also makes my nose run more than usual nowadays. So I do think it can be a thing…but I doubt there are any official studies on this one. But yes, nightshades are discussed often on the alternative medicine circles. But some just take out the spicy ones which helps expand possible foods.
Thank you for all of your input Mike. As I have been allergic to eggplant since I was a teenager and have noticed increasing severity in my reactions to nightshade plants with repeated exposure, I will continue to avoid all nightshades and not just the spicy ones. It’s not a choice or a preference for me. Though with the recent popularity in alt med circles about cutting out nightshades for all kinds of health benefits, my sensitivity is certainly recieved as a fad diet preference on the regular.
More studies coming out on gluten links to Hashimoto’s thyroiditis. This study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5897856/ discusses a high incidence of non-celiac gluten sensitivity and Hashimoto’s. I can tell you that over and over hashimotos patients have found relief avoiding gluten. My sister just recently went gluten free and said that’s made the biggest difference for her of anything she’s tried before. Again, this doesn’t mean it’s going to fix everything…the damage to the thyroid has been done. But, it can make a big difference for quality of life and indirectly impacts the treatment of hypothyroidism. For instance, improving mental aspects, reducing nutrient deficiencies, and for me making for much better stools, which the paper industry may be sad about…but my rear is happy. Again…the key here is they don’t have to be officially celiac to see a difference. And this is common to many autoimmune deceases. A gal at work has Vitiligo and has clear gluten reactions and pays for it everytime she strays.
It’s nice that these authors attempted to approach NCGS in a scientific way, but the paper spends a fair amount of time talking about the extra-intestinal manifestations of actual celiac disease. It almost appears to conflate CD and NCGS in many spots. In addition, the authors talk a lot about patients with positive anti-gliadin antibodies, which are often a marker for true CD. But they seem to imply that many of these AGA+ patients have NCGS, which I’m not sure is true.
I am still unimpressed with the assertion by many that stopping gluten will have a direct beneficial effect on the thyroid. Nonetheless, stopping gluten can be great for one’s health, given that a low-starch approach to eating is probably healthier than what most people do now.
Thank you for your great review of this article HD. I am frustrated by the amount of “science based” claims that extrapolate findings from one autoimmune disorder treatment to another completely different disorder. Is there research about lifestyle interventions for reducing autoimmunity in general? Or are there too many confounding factors?
As you allude to, I think there are too many kinds of autoimmune disorders to generalize about the impact of lifestyle modifications on them. But in general, many people will be better able to cope with their diseases when they eat clean and exercise well. Not a profound answer, I realize.
I go once a month to a health food store for this or that, and often find older people there looking for something to “increase my metabolism”, complaining of gaining weight, feeling cold, etc.
This last week I was in the store and asked a woman, whom the employee was directing to herbal products to increase metabolism, if she use iodized salt… “no, I use Kosher salt”. Then I asked if she ate fish or took fish oil supplements….” no, I avoid fish and fish products”. I had noticed she had a thick swollen-looking neck, which is often a sign for thyroid problems, which is why I questioned her.
I spent a half hour explaining to her that her thyroid needs iodine to make the thyroid hormones her body needs to function and keep her metabolism up. No one told her when she switched from iodized salt to kosher salt, because it was supposed to be better for you, that she was eliminating the only source of iodine in her diet. And that after awhile she would develop thyroid problems from that lack of iodine. And the store employee did not inquire either, before suggesting an herb that would never help her in a million years, when the problem was apparently a simple lack of iodine in the diet.
I find older people will avoid iodized salt, either on their own or their physician tells them to stop using salt. And the salt was their only source of iodine! No wonder they become Hypothyroid. And their physician does not tell them when stopping iodized salt, to get themselves another source of iodine to replace it, either.
I had to stop using salt because of an allergy to dextrose, which they put in table salt. And I found a capsule supplying iodine, but it supplies 667% of the daily requirement! So I have to open the capsule and use a tiny amount each day, each capsule lasts me almost a week. But how many people are taking that capsule once a day and getting too much iodine? People are ignorant when it comes to iodine, and I find they often will be taking too much, afterall the capsule has that much in it so it must be ok to take it. And is a little is good, then more must be better.
You have to be careful with Iodine though. In high doses it can trigger hashimotos and cause hypothyroidism. Do you need some, sure. But not a whole lot of it.
Which is why I wrote in my post that many iodine supplements supply too much iodine, and a single iodine capsule lasts me almost a week. And there are crazy websites out there on the web, that recommend large doses of iodine, which is crazy and a sure way to make a thyroid malfunction. More is definitely not better when it comes to iodine.
Hi I am curious. I’ve been told I have lots of inflammation from my endocrinologist as well as my gynecologist. What does ones to get the inflammation down? My doctor suggested going gluten-free and I’m wondering if that’s accurate or if there’s something else I need to be doing. Everything that I read said inflammation is caused by gluten and I’m wondering if that’s true or not. It’s really hard to Wade through all this information.
[HD: Redacted – This reader is giving some advice that is not evidence-based.]
I have been tested and don’t have celiacs. I am wondering my I feel less bloated and lighter when I eat gluten free?
The composition of various grains varies in their amino acid contents and their grain wall toughness.
Before I was diagnosed with Celiac Disease, I tried various older type wheats. Kamut made my symptoms worse, however I tolerated anything made of Spelt fairly well with minimal symptoms or digestive problems.
You could try one of the older grains to see if you tolerate one of them better. Newer grain varieties were developed to be more tolerant to different climates, soil conditionswinter wheat varieties, etc. This means grains that are different in structure.
Thank you. My numbers are good and I can’t seem to lose weight either. I workout, eat better and weight is stalled. I was told gluten free world help. Honestly, I don’t know which way is up.
[HD: Redacted. Dubious advice]
There are multiple studies in PubMed showing a clear association between Celiac Disease and various autoimmune diseases such has Hashimoto’s (17%), Asthma(7%), Type 1 Diabetes, Dermatitis Herpetiformis, Autoimmune Hepatitis, Sjogren and arthritis being the most common in decreasing order.
[HD: Redacted. Off-topic. This is not the venue for an in-depth discussion of celiac disease.]
[HD: Redacted. Dubious advice and off-topic.]
Another study linking Hashimotos and Coeliac disease: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4146952/
While these studies may not show 100% of people fall into this situation. It’s a pretty high percentage. Question would be if you completely do not have Coeliac, would you still benefit from going GF with Hashimotos…
Sure, there’s a relationship between Hashimoto’s and celiac. But in the absence of celiac, going GF for Hashimoto’s has no evidence to support its utility.
Well, my daughter (11 who has Hashimotos) has now been diagnosed with Celiac. Luckily I already have been gluten free and can provide some help with that. I didn’t test for Celiac because I was already off of it for a month and didn’t want to go back on it to test. I can say for me I lost bloating and gas after going off of it, but I also went off dairy at the same time. The majority of men in the hashimotos men group I am in react to gluten and have removed it. She’s not on medicine for Hypothyroidism, but does seem to have fluctuating thyroid levels. TSH tests have been between 3-5 so far. Hopefully this calms things down for her.
I am curious, in my hashimoto group there are people that claim to have reversed their Hashimoto’s with nutrition. It’s that possible?
Reversing is something I don’t agree with. Stopping is possible. This is assuming diet is your issue. There are people who are able to figure out what was causing their autoimmunity. For instance, for some people dental issues maybe causing it. Fixing those issues stops the attack. However, you still have hashimoto’s. It could flair up again in the future for a different reason. The most common foods patients avoid are gluten, dairy, and soy. I personally would add added sugars to that list. I suggest this could be worth a trial especially if you are still struggling on medication.
To be clear, the vast majority of people who manipulate their diet to stop the autoimmune attack on the thyroid will be spinning their wheels. Anecdotally, some people may report feeling better with dietary manipulation, but there are usually too many confounding variables to say the diet helped the thyroid situation.
I would also assume once the damage is done, the thyroid likely does not regenerate at any appreciable level. So even if you stopped the hashimotos side of things, your hypothyroidism (assuming you have it) would remain. You just wouldn’t have further damage requiring an increase in hormone unless more future attacks occurred. Still, I would want to stop the attack if at all possible. And if you can find the reason that’s stoking the hashimotos, that’s a good thing to remove.
Thank you for writing this. I love your website and it’s been so useful in helping me separate the information from the misinformation.
I was wondering what you thought of this paper about zonulin and impaired gut function, which is often cited by people attempting to treat ‘leaky gut’ in autoimmune disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384703/
Also, this article by science-based medicine seems to suggest that NCGS might still exist, even though the evidence is mixed: https://sciencebasedmedicine.org/gluten-update/
If this is the case, then wouldn’t it be prudent for people to limit eating it (when you have an autoimmune issue, you’re often willing to take even a small chance of feeling better)
I’d appreciate your views on this.
The first citation you linked to is outside my area of expertise, so I’ll refrain from commenting on that (plus, I really don’t want to read that article). The SBM article is more negative than positive on the existence of NCGS as a “thing,” noting that it is a shaky hypothesis built on minimal evidence. However, as I’ve said before, I see people without celiac stop eating gluten, and they sometimes feel better. I suspect it is mostly because they’re cutting out starchy carbs and other crap in the diet, replacing it with healthier alternatives. In general, I do favor an approach to eating that is lower in starchy carbs/grains and higher in vegetables, fresh fruit, nuts, seeds, chicken, fish, and meat.
Thank you for putting this platform full of information out there! This is all new to me and I have a lot of reading to do. 🙂
On this point I am afraid of the opinion that most of our health problems are triggered by what we eat. However, the tragedy is that we start paying attention to what we eat when problems start to pile up. Then – miracle pills, supplements and fad diets are thrown in the mix as a last resort to try and fix everything – usually years of neglect.
Prevention and all in moderation is key.
On the prevention point, I was curious – are there any studies/trials that included “patients” with a milder and/or subclinical hypothyroidism who reduced their TSH due to specific nutritional guidelines? I added the “ on the word patients because as I understand – there is lot of discussion in the medical field about treating subclinical hypothyroidism or not.
Any links you can share on this will be kindly appreciated!
It’s a fair question. I know there are studies looking at giving iodine to mildly iodine deficient patients with SH, or iron to mildly iron deficient patients with SH. But I don’t believe I’ve ever seen a general dietary intervention study for SH.
There have been research studies showing gluten free diets have reduced autoimmune response in Hashimoto’s and they’re leaning towards molecular mimicry playing a role in that.
Objectively, they have seen drops in antibody counts. This would not be a treatment or solution to Hashimoto’s, rather, it would reduce an inflammatory immune response / attack against the thyroid. Potentially meaning you having your thyroid around for longer, experience less fatigue, less inflammation, and can last longer on dosages before having to increase.
There is a lack of research, yes, but I think making such a definitive statement due to a lack of research is dangerous, especially when clinically speaking there has been a lot of evidence towards benefiting from the gluten-free diet in terms of drastic changes in fatigue, longer time periods between having to increasing dosing, etc.
As a physician with Hashimoto’s, and someone who is very evidence and research driven, I do believe that there is validity in patient experiences, dietetics and nutrition research, and the possibility of this being a helpful recommendation for Hashimoto’s patients.
A very recent review of studies suggests that gluten-free diets are not required: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468712/
Please cite a reference that shows a GFD for people without celiac disease can be helpful with respect to the thyroid.
$11000 funct med dr which includes supplements and shakes, no dairy, grains or sugars, only use olive or avocado oils and lots of water. Endo gave me Levo low dose and tsh levels dropped to normal. Triglycerides dropped in half. Was it the rx or the food? Sad if its all for naught.
My TPO antibodies are over 13k, TSH, T3 and T4 are all in normal range, I don’t have any symptoms, but they gave me a diagnosis of Hasimotos……so what do I do now to try to stay asymptomatic? Someone told me to eliminate iodine ? Add selenium ? So confusing ,,,,,,thx
The Ultimate Guide to Thyroid Function Testing – Hypothyroidism Edition
Selenium and the Thyroid – Secrets Your Naturopath Doesn’t Want You to Know